Breakthrough research by Mass General Brigham and UC San Diego scientists has finally identified the gut bacteria responsible for auto-brewery syndrome, a rare condition causing individuals to become intoxicated without consuming alcohol. Published in Nature Microbiology, this discovery sheds light on the precise biological pathways involved in this mysterious ailment.
For years, people suffering from auto-brewery syndrome (ABS) faced profound challenges, including misdiagnosis, social stigma, and serious medical and legal complications linked to unexplained intoxication. The inability to pinpoint the exact cause often left patients without adequate care or understanding, exacerbating their suffering.
This new understanding of the auto-brewery syndrome cause offers a critical turning point. It promises to transform how the condition is diagnosed and treated, moving beyond the current difficult and often inaccessible supervised blood alcohol tests, as reported by ScienceDaily on January 13, 2026.
Unraveling the gut’s secret brewery
The research team meticulously studied 22 ABS patients, alongside unaffected partners and healthy controls, to compare the composition and activity of their gut microbes. Laboratory tests confirmed that stool samples from patients during flare-ups produced significantly more ethanol than those from control groups.
This crucial finding paves the way for a more reliable and accessible stool-based diagnostic test, a significant improvement over current methods. Specific bacterial species, including Escherichia coli and Klebsiella pneumoniae, were identified as key contributors to this internal alcohol production.
Furthermore, patients experiencing symptoms showed elevated levels of enzymes critical for fermentation pathways, offering deeper insights into the underlying mechanisms. Identifying these precise microbes and pathways has been a complex, time-consuming endeavor, marking a major scientific advance according to Mass General Brigham researchers.
Hope for diagnosis and treatment
The study also highlighted the potential of fecal microbiota transplantation (FMT) as a therapeutic approach. Researchers followed one patient whose severe ABS symptoms significantly improved after receiving an FMT when other treatments had failed.
Dr. Elizabeth Hohmann, co-senior author from the Infectious Disease Division at Mass General Brigham, emphasized the study’s implications. “Auto-brewery syndrome is a misunderstood condition with few tests and treatments. Our study demonstrates the potential for fecal transplantation,” she stated.
This patient’s periods of relapse and recovery directly correlated with changes in specific gut bacterial strains and metabolic activity. After a second fecal transplant, utilizing a different antibiotic pretreatment, the individual remained symptom-free for over 16 months, offering compelling evidence for FMT’s efficacy. Dr. Hohmann’s team is now evaluating FMT in eight additional ABS patients in a follow-up study with UC San Diego.
The identification of specific gut bacteria and biological pathways behind auto-brewery syndrome represents a monumental step forward for affected individuals worldwide. It not only offers a clearer path to accurate diagnosis but also opens new avenues for targeted treatments, potentially alleviating years of suffering and misunderstanding for those living with this rare condition. The future of ABS management appears brighter than ever.
